What You Need To Know Right Now About Medicaid And Medical Assistance

Many seniors have questions regarding Medicaid, whether or not they are eligible for coverage and what that coverage entails. This overview provides background information and answers Medicaid related questions. Medicaid is a medical care program between the federal government and states that provides medical care for eligible individuals who are aged, blind or disabled. States participating in the Medicaid program must comply with all federal statutory requirements in order to qualify for federal money. States must also develop a plan that includes reasonable standards for determining eligibility.

Medical Assistance Is Minnesota's Medicaid Program

Every state has its own Medicaid program and may differ considerably. Minnesota calls its Medicaid program Medical Assistance. Medical Assistance provides health care coverage for financially eligible Minnesota residents who meet one or more of the following criteria:

Under 21 years old

65 years old or older

A parent of a dependent child

A caretaker of a dependent child

A pregnant woman

A person who is certified blind

A disabled person

Medicaid And Medical Assistance Benefits

Medical Assistance pays for most medically necessary services, including home health care and long-term care services. Some of the services covered are:

Inpatient hospital services

Emergency room services

Skilled and intermediate nursing care

Laboratory and x-ray services

Eyeglasses

Dentures

Prosthetic services

Home health services must be medically necessary, ordered by a physician, provided in the recipient’s residence and documented in a written case plan.

Medicaid And Medical Assistance Eligibility

The eligibility requirements for Medical Assistance in Minnesota are as follows:

You must be a resident of Minnesota

You must meet citizenship requirements

You must be financially eligible

You must complete an application

All eligibility requirements must be verified

To be a resident, a person must be physically present in Minnesota voluntarily and must not have a home elsewhere. A person may not receive Medical Assistance from more than one state at a time. Applicants can prove citizenship by showing a birth certificate, showing that the individual was born to U.S. parents outside the U.S. or showing naturalized citizenship documentation. All people 65 years and older who meet these criteria are automatically eligible for Medical Assistance.

Medicaid And Medical Assistance Are Need Based

Medical Assistance is a need-based program. A recipient’s assets cannot exceed $3,000 and a person’s income must be less than 100% of the Federal Poverty Guidelines (FPG), which is currently $817 per month. If an individual’s income is over 100% of FPG there is a "spend down" option. A person can spend down to 75% of FPG which is currently $613 per month.

Medical Assistance Is Administered By Counties

The Minnesota Department of Human Services is responsible for the administration of the Medical Assistance Program. The responsibility of working with eligible individuals (e.g., applications), is delegated to county agencies. A health care program manual containing Medical Assistance instructions is issued to various county financial workers by the Minnesota Department of Human Services. The manual and other helpful publications can be found here: Department of Human Services.

Medicaid And Medical Assistance Can Help In Your Home

Community and Home-based waiver programs were established under the Social Security Act of 1981. Waiver programs were established to correct institutionalized bias in Medicaid programs. Waivers allow states to offer home and community-based services to people who may otherwise be institutionalized. Minnesota has waiver programs that not only help seniors, but infants, those suffering brain injuries and debilitating illnesses, too. For example, Minnesota has a Medicaid waiver designed specifically for individuals over 65 years old called the Elderly Waiver program. This Community Alternative for Disabled Individuals (CADI) Waiver is a program designed for disabled individuals under 65 who require nursing home level of care, but choose to reside in the community.

Medicaid And Medical Assistance Can Be Confusing

This information is only an overview of Medicaid and Medical Assistance in Minnesota. One size never fits all and your questions deserve specific answers. For a detailed and substantive understanding of Medicaid, Medical Assistance eligibility and waiver programs you ought to discuss your needs with an expert.